Risky Drinking and Preventive Medical Service Use Among Older Adults

Excessive alcohol use among elders can present risks for a variety of poor outcomes. We examined whether drinking that exceeds recommended limits is associated with lower likelihood of receiving preventive medical services. We conducted a cross-sectional analysis of a nationally representative sample of elderly Medicare beneficiaries, using the 2003 Access to Care file of the Medicare Current Beneficiary Survey (N = 12,413). Risky drinking was defined in relation to two parameters of recommended limits (monthly use exceeding 30 drinks per typical month—based on the weekly limit of 7 drinks— and/or "heavy episodic" drinking of four or more drinks on any day during a typical month in the past year), utilizing self-reported survey data. Receipt of preventive services (influenza or pneumonia vaccination, glaucoma screening, mammogram) was determined using survey and claims data. Prevalence of risky drinking was 9% (16% for men and 4% for women). Elders exceeding either parameter of drinking guidelines were less likely than within-guidelines drinkers to receive preventive services including influenza vaccination (66.3% versus 73.7%, p<.01) and glaucoma screening (42.4% versus 53.3%, p<.01). In multivariate analyses, episodic heavy drinking was associated with lower likelihood of receiving influenza vaccination (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.58-0.96), pneumonia vaccination (OR 0.75, CI 0.59-0.96) or glaucoma screening (OR 0.71, CI 0.56-0.91). These results suggest that excessive drinking may constitute a risk factor for failure to receive preventive care among elders, and can inform the efforts of health care providers and others working with elders to improve service delivery.